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Our research has shown that only one in three Australians with a strong family history of colorectal cancer report screening colonoscopy practice appropriate to their level of risk. We also know that about half of Australians from mutation-carrying families at risk of inherited colorectal cancer (Lynch syndrome) have irregular or no screening colonoscopy despite most of them overestimating their risk of getting CRC in the next 10 years. The majority of those attending a GP reported they were are not asked about their family history of colorectal cancer and less than a third reported having ever receiving screening advice from a health care provider.

It is not known what high-risk individuals understand about their own family history, whether they have disclosed such information to a clinician, and whether the clinician provided screening advice based on this information. To address these gaps, we are conducting a population-based study of the screening behaviours of Australians at various levels of colorectal cancer risk including average and high risk of colorectal cancer, and investigating which factors are associated these screening behaviours.

Our research team includes international leaders in the identification of colorectal cancer risk factors and prevention.  We have investigated all previous colorectal cancer prediction models and have found none that adequately address all risk factors. Much additional research remains to complete these models. We will pursue the identification of new genetic variants found to be associated with colorectal cancer risk. We will attempt to identify features of colorectal cancer tumour and pre-malignant polyp pathology that help predict the cancer risk for the relatives of people with colorectal cancer, and we will investigate the risk factors for those people with colorectal cancer that predict who will go on to develop a second colorectal cancer, and whose family members may also be at risk of the disease.

We will develop a comprehensive risk prediction model to deliver accurate individual predictions across the full spectrum of colorectal cancer risk by using family history data, as well as data on the presence or absence of all known genetic and other risk factors including lifestyle factors (e.g. diet, physical activity, smoking, alcohol), medical procedures (e.g. medications and screening) and personal characteristics (e.g. BMI and sex). We will do this in two stages: first, we will develop the CRC risk prediction model using measured genetic information, the multi-generational cancer family history data, and the information on all known risk factors. Next we will test this model against all existing predictive models using our large population-based study, the Colon Cancer Family Registry Cohort.

We will convert this risk model into a risk prediction tool for clinical practice that will facilitate more appropriate screening recommendations to reduce the burden of disease and maximise cost effectiveness of screening. We will perform a series of pre-clinical studies of different user groups (consumers, GPs and practice nurses) to test alternative designs, data collection and risk presentation formats. These studies will inform the design of the risk assessment tool which will be evaluated in a range of clinical settings outlined below. 

Our approach to reduce the burden of CRC is to use the comprehensive risk prediction tool systematically in general practice. Each year, 85% of Australians visit a general practice. General practices already play a major role in disease prevention through screening for other diseases and risk factors such as cervical cancer, hypertension, diabetes risk factors such as smoking. We know that the interactions surrounding clinical advice and patient behaviours are complex and that changing people’s behaviour, including that of doctors, is not easy. We will address this by using identified strategies to overcome barriers in achieving best clinical practice, led by our international clinical translation research team. We will work with all staff from a range of general practice types and sizes. This sampling approach will allow us to identify some of the factors that affect uptake of the tool.